IST – The HEE perspective Paul Sadler Interim PG Dean HEE Wessex

Why am I here? Collaboration HEE and RCS Lead Dean for IST (& 2 surgical SACs) My background Critical Care and Anaesthesia CCrISP / ATLS Course Director Director of Education / Deputy Medical Director Common issues in the past “missed training opportunities” “no time in theatre” “no one else on wards” “supervisors have no time” “service focus” “ok as long as rota is full” “if get to theatre I just hold the retractor” “teaching just doesn’t happen” “I felt isolated” Backed up by JCST / GMC survey

IST: History 2013 Shape of Training report published 2014 HEE mandated to explore implementation of Shape recommendations 2015 IST report commissioned by HEE, produced by RCS 2016 IST project funded by HEE 2018 Planned start of IST pilot

Improving Surgical Training A new competence-based, run-through training programme in General Surgery. HEE and RCS working together The pilot will trial: improvements in the quality of training, better balance between service and training, professionalise the role of the trainers Develop members of the extended surgical team to work alongside surgical trainees to improve patient care

The HEE Perspective HEE Perspective There is no more money CCT not CST Consider the patient and service perspective Consider the wider team Don’t be constrained by traditional boundaries FY2 Be radical

HEE Perspective Define the Service Define the Team composition Define the role of the Consultant Define the Training Programme

Process Induction High Volume, Low Risk Low Volume, High Risk Intensive Boot camp Simulation Human factors High Volume, Low Risk Modular High level of support and supervision Day Unit, Surgical Assessment Unit, Emergency theatre etc Supplemented by refreshers Low Volume, High Risk More independent

Process Surgery: HEE trainee perspective Periods of Acute/Core Skills ITU and peri-operative medicine Generic surgical technical skills Non-clinical skills On-calls Simulation Periods of ‘Intensive surgery’ Specialist surgery Acute/trauma training Longer rotations No on-calls Periods of Specialist Surgery with on-calls Specialist on-calls Post-CCT: Fellowships for sub-specialisation Upkeep of acute, general and specialist skills

Project Principles Enhanced training Increased time for training (60%) Professionalised, better-trained trainers Simulation Technical and Non-Technical Skills Extended Surgical Team Surgical Care Practitioner curriculum – related to ISCP Re-structuring of rotas Minimum of 10 in a full shift ‘cell’, including non-medical workforce in Core-level on-call rota Curriculum modification “Excellence by Design” Embedded, enhanced induction (‘boot camps’) Centrally managed and funded post-CCT fellowships True competence-based progression Run-Through progression (with min and max duration and enhanced ARCP) Think back to those comments trainees made at the beginning

Improving Early Years Training Improved quality of core training Apprentice style training Better and more simulation Better preparation in foundation Longer placements Adjusted service role Broader based training Changed structure of surgical team What constitutes simulation needs to be clear What is training often still needs explaining Foundation review is happening across the board

HEE ARCP Review The purpose of the ARCP process should be recognized as:   Assessment of competence to progress to the next stage / completion of training Ensuring trainees fulfil GMC revalidation requirements Ensuring trainees are regularly appraised receiving formative feedback and careers advice A consistent, robust and fair process

HEE ARCP Review Assessment – meaningful and achievable Appraisal ES / CS role ARCP members role QA of ARCP Logbook and case numbers important Value of CEX as opposed to a MCR in demonstrating achievement of required competence

HEE Plans Schools started What works What doesn’t Plans for expansion Schools not started Plans to start If not why not No support Not possible Local HEE Offices Deans Employers Trainer job plans Promote EST Local Champions (£5k)

Challenges Moving to business as usual School / Employers Rotas Trainer Time Simulation access What is simulation? ST3 numbers EST

?

Summary Holistic review of Surgical Training Protects training time Emphasis on the value of the trainer Requires changes in EST to make it work Values General / Acute work through programme Good for patients? I WANT TO BE HERE!